heroin and Kidney-Diseases

This article reviews the pharmacokinetics of heroin after intravenous, oral, intranasal, intramuscular and rectal application and after inhalation in humans, with a special focus on heroin maintenance therapy in heroin dependent patients. In heroin maintenance therapy high doses pharmaceutically prepared heroin (up to 1000 mg/day) are prescribed to chronic heroin dependents, who do not respond to conventional interventions such as methadone maintenance treatment. Possible drug-drug interactions with the hydrolysis of heroin into 6-monoacetylmorphine and morphine, the glucuronidation of morphine and interactions with drug transporting proteins are described. Since renal and hepatic impairment is common in the special population of heroin dependent patients, specific attention was paid on the impact of renal and hepatic impairment. Hepatic impairment did not seem to have a clinically relevant effect on the pharmacokinetics of heroin and its metabolites. However, some modest effects of renal impairment have been noted, and therefore control of the creatinine clearance during heroin-assisted treatment seems recommendable.

Topics: ATP Binding Cassette Transporter, Subfamily B, Member 1; Drug Interactions; Heroin; Humans; Kidney Diseases; Liver Diseases; Morphine; Morphine Derivatives

Since the first reports in the late 1960s and early 1970s there have been numerous studies describing the clinical and pathological features of renal diseases associated with chronic parenteral abuse of heroin, cocaine, morphine, amphetamine, and other narcotic and hallucinogenic drugs, including several adulterants. The past 35 years have witnessed an explosive growth in illicit drug use in many parts of the world. Meanwhile, drug addict nephropathy constitutes an important cause of end-stage renal disease. The term heroin-associated nephropathy' includes different morphological findings following chronic drug abuse. Up to now it still remains ambiguous as to whether or not heroin/morphine itself, adulterants, other diseases like hepatitis B and C infection, or HIV, lead to a spectrum of morphologically described heroin-associated' findings in the kidneys. As a measure of prevention it appears that the purity of heroin plays an important role.

Topics: Hepatitis B, Chronic; Hepatitis C, Chronic; Heroin; Heroin Dependence; HIV Infections; Humans; Kidney Diseases; Narcotics

The most important task of clinical and experimental nephrology is to identify risk factors for progression of renal failure with the ultimate goal to counteract the dramatic increase of patients reaching end-stage renal disease. Recently, cigarette smoking has been recognized to be one of the most important remediable renal risk factors. The adverse renal effects of smoking seem to be independent of the underlying renal disease and the current evidence suggests a near doubling of the rate of progression in smokers vs. non-smokers. Cessation of smoking slows the rate of progression. Besides smoking, alcohol abuse has also been implicated as a renal risk factor. The present article reviews the current knowledge about the adverse renal effects of these legal drugs. Furthermore, the acute and chronic renal complications due to illegal recreational drugs is discussed. The impact of these drugs on the risk to reach end-stage renal failure is difficult to assess, which is mainly due to the fact that it is difficult to perform controlled prospective studies in substance abusers. According to estimates, 5-6% of new patients starting end-stage renal disease therapy may have opiate-use-related renal diseases in the USA--a figure which documents the magnitude of the problem. Thus, in any case of unexplained renal functional impairment substance abuse should be considered by the physician.

Topics: Acute Kidney Injury; Adolescent; Adult; Alcoholism; Amphetamines; Anti-Anxiety Agents; Benzodiazepines; Cocaine; Drug-Related Side Effects and Adverse Reactions; Hallucinogens; Heroin; Humans; Illicit Drugs; Kidney; Kidney Diseases; Kidney Failure, Chronic; Male; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Nephrotic Syndrome; Odds Ratio; Risk Factors; Smoking; Smoking Cessation; Substance-Related Disorders; Temazepam

Topics: Adult; Amphetamines; Heroin; Humans; Kidney Diseases; Male; Narcotics; Psychotropic Drugs; Substance-Related Disorders

Topics: Animals; Anti-Glomerular Basement Membrane Disease; Anti-Inflammatory Agents; Antibodies; Captopril; Drug Hypersensitivity; Environmental Exposure; Glomerulonephritis; Gold; Heroin; Humans; Hydrocarbons; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Immune Complex Diseases; Kidney Diseases; Kidney Glomerulus; Lupus Erythematosus, Systemic; Mercury; Nephritis, Interstitial; Penicillamine; Penicillins; Rifampin

Topics: Amyloidosis; Heroin; Humans; Kidney; Kidney Diseases; Northwestern United States

Drug abusers, particularly those who inject drugs s.c. ("skin popping"), may develop amyloidosis. Chronic infections are thought to play a pathogenetic role in this setting. A patient is presented who had a history of "skin popping" cocaine and heroin and developed nephrotic syndrome, with an elevated serum creatinine and a creatinine clearance of 61 mL/min. Renal biopsy demonstrated amyloidosis. Treatment with colchicine was initiated, and proteinuria decreased to near normal levels after 12 months. Concomitant with the decrease in proteinuria, creatinine clearance improved, although a repeat renal biopsy failed to show any significant improvement in amyloid burden. These observations suggest that colchicine may be a useful treatment in reversing the proteinuria of renal amyloidosis associated with drug abuse. Furthermore, clinical improvement may occur before any demonstrable regression in the amyloidosis.

Topics: Adult; Amyloidosis; Cocaine; Colchicine; Female; Heroin; Humans; Injections, Intravenous; Kidney Diseases; Substance-Related Disorders

Topics: Adult; Amyloidosis; Female; Heroin; Humans; Kidney Diseases; Nephrotic Syndrome; Remission, Spontaneous; Substance-Related Disorders

Thirteen patients developed a renal disease after using heroin alone or in combination with other drugs, for a period of 3 to 12 years. Eleven were IV drug addicts, 2 were sniffers. Six patients had acute tubular necrosis, due to rhabdomyolysis in 5 and to prolonged gentamicin therapy for bacterial endocarditis in 1. Five patients manifested a nephrotic syndrome, and renal biopsy showed various types of glomerulonephritis (GN) without glomerular sclerosis. The two last patients had hypertension with intrarenal vascular lesions and HBsAg was present in their serum. Chronic hemodialysis and/or renal transplantation were required in 2 cases with GN; all other patients recovered normal serum creatinine. There was no specific pathologic picture of heroin abuse in this series.

Topics: Adult; Endocarditis, Bacterial; Female; Gentamicins; Glomerulonephritis; Heroin; Humans; Hypertension, Renovascular; Kidney; Kidney Diseases; Kidney Tubular Necrosis, Acute; Male; Rhabdomyolysis; Substance-Related Disorders

Systemic amyloidosis has recently emerged as a major cause of nephropathy among heroin abusers in New York City. Although focal glomerulosclerosis is typically seen in intravenous drug abusers who present with the nephrotic syndrome, those who escape this complication are at risk for the later development of amyloidosis related to their use of the subcutaneous route. Twenty such addicts identified between 1981 and 1984 are described. Patients typically present with chronic suppurative skin infections, edema, the nephrotic syndrome, benign urinary sediment, and normal-sized or enlarged kidneys. Tubular dysfunction, particularly renal tubular acidosis and diabetes insipidus, is frequent. Progression of renal insufficiency is characteristically rapid. Prolonged survival of heroin abusers and exhaustion of intravenous access requiring recourse to the subcutaneous route underlie the occurrence of amyloidosis in the addict population. Chronic suppurative skin infection consequent to repeated subcutaneous injection appears to be the underlying cause.

Topics: Adult; Amyloidosis; Female; Heroin; Humans; Injections, Subcutaneous; Kidney Diseases; Male; Middle Aged; Substance-Related Disorders

Heroin-associated nephropathy (HAN) is a complication of the intravenous use of heroin or cocaine. It has been postulated that one of the substances used to adulterate these drugs may be responsible for the renal injury. We examined data provided by the Drug Enforcement Administration (DEA) concerning the laboratory analysis of 12 366 samples of heroin/cocaine. These street-grade drugs were analyzed for the presence of various adulterants or secondary substances. Eleven adulterants were identified with a frequency of occurrence that exceeded 5%. Quinine, mannitol, lactose and procaine were the non-narcotic compounds most commonly found. Other substances found included caffeine, inositol, lidocaine, starches, methapyrilene, sucrose, acetylprocaine and dextrose. No specific substance including heroin or cocaine has yet been definitely implicated as causative of HAN. These data suggest that further animal research is needed to determine the effects of repeated intravenous injections of each of these commonly found substances on the kidney.

Topics: Cocaine; Drug Contamination; Drug-Related Side Effects and Adverse Reactions; Heroin; Humans; Illicit Drugs; Kidney Diseases; Lactose; Mannitol; Procaine; Quinine

Topics: Acute Kidney Injury; Glomerulosclerosis, Focal Segmental; Heroin; Heroin Dependence; Humans; Kidney Diseases; Nephrotic Syndrome

Topics: Captopril; Daunorubicin; Gold; Heroin; Humans; Kidney Diseases; Kidney Glomerulus; Mercury; Microscopy, Electron; Penicillamine; Puromycin; Sulfadiazine; Trimethadione

Heroin addiction is associated with several severe and occasionally fatal renal complications. Acute renal failure consequent to rhabdomyolysis and myoglobinuria, when treated supportively, carries a good prognosis. Staphylococcal or other bacterial septicemia may in itself prove fatal and is associated with a proliferative immune complex, acute glomerulonephritis, which generally follows the course and prognosis of septicemia. The necrotizing angiitis reported in heroin addicts still is largely undefined. Focal and segmental glomerular sclerosis is the most common pathologic finding in the syndrome of heroin-associated nephropathy (HAN). Typically, HAN presents with massive proteinuria and progresses rapidly to renal failure. Presumptive evidence supports the premise that heroin or its vehicles elicits immunologically mediated renal damage. The antigen still is unidentified. Removing the antigenic challenge by stopping heroin injection apparently interdicts the progression of renal disease. Renal transplantation can be effectively accomplished in patients with HAN without early recurrence if patients discontinue the use of heroin.

Topics: Acute Kidney Injury; Adult; Female; Glomerulonephritis; Heroin; Heroin Dependence; Humans; Kidney Diseases; Kidney Transplantation; Male; Middle Aged; Myoglobinuria; Polyarteritis Nodosa; Prognosis; Proteinuria; Sepsis; Syndrome; Transplantation, Homologous

Topics: Animals; Heroin; Heroin Dependence; Humans; Kidney; Kidney Diseases; Mice

Topics: Adult; Basement Membrane; Biopsy, Needle; Blood Pressure; Fluorescent Antibody Technique; Hepatitis B Antigens; Heroin; Heroin Dependence; Humans; Immunoglobulin G; Kidney; Kidney Diseases; Microscopy, Electron; Middle Aged; Proteinuria; Substance-Related Disorders

Topics: Abscess; Adult; Autopsy; Diagnosis, Differential; Disseminated Intravascular Coagulation; Endocarditis, Bacterial; Heroin; Humans; Infarction; Kidney Diseases; Lung Abscess; Male; Myocardium; Pleural Effusion; Pulmonary Embolism; Splenic Diseases; Splenic Infarction; Staphylococcal Infections; Staphylococcus; Substance-Related Disorders; Tricuspid Valve